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  3. 10. Role of Cerebrospinal Fluid Pleocytosis and its Biochemical Parameters in the Diagnosis of Aseptic Meningitis
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10. Role of Cerebrospinal Fluid Pleocytosis and its Biochemical Parameters in the Diagnosis of Aseptic Meningitis

Muhammad Usman Anjum1, Mohammad Mushtaq2, Syed IrfanRaza Arif3 and Arshad Wahab Shah4


Objective: To assess the role which CSF pleocytosis and its different biochemical parameters play in the diagnosis of aseptic meningitis,

Study Design: Prospective study

Place and Duration of Study: This study was conducted at the Frontier Medical College, Abbottabad from July 2017 to April 2018.

Materials and methods: All patients of both genders who were between the ages of 10 - 30 years and who were admitted with a suspected diagnosis of meningitis were included. All those patients who were suspected of suffering from fungal or tuberculous meningitis or who had traumatic lumbar puncture (LP) and those patients who were administered antibiotics prior to their LP were excluded. An experienced clinician made the diagnosis of meningitis considering history, physical examination as well as CSF results with significant emphasis laid on symptoms and signs of meningeal irritation (SOMI). CSF examination comprised of white blood cell count with quantification of neutrophil and lymphocyte counts, CSF protein & glucose levels and CSF Gram and ZiehlNeelsen (ZN) staining.

Results: There were 64 patients in this study. Out of which, 44 were male patients and 20 were female patients with a male to female ratio of 2.2:1. Fifty one patients, (79.69%), suffered from aseptic meningitis while 13 (20.31%) patients were suffering from bacterial meningitis. There were 51 patients who had aseptic meningitis and out of these, 37 patients were males while 14 patients were of female gender. Similarly, out of 13 patients who were diagnosed with bacterial meningitis, 07 patients were males while 06 patients were female. In patients with bacterial meningitis, white blood cell (WBC) count was distinctly higher and the predominant cell type was neutrophils while, on the other hand, lymphocytes were the chief WBC type in patients having aseptic meningitis. The mean protein levels were significantly raised in the CSF of patients who had bacterial meningitis in comparison to that of aseptic meningitis. Patients with bacterial meningitis exhibited distinctly lower levels of CSF glucose levels in comparison to those patients who had aseptic meningitis. Nearly all patients who were suffering from aseptic meningitis exhibited CSF lymphocytosis whereas 76.92% of patients who were suffering from bacterial meningitis had predominance of neutrophils.

Conclusion: Examination plays a pivotal role in the diagnosis of uncomplicated cases of meningitis. This is especially true when the CSF results were interpreted along with clinical findings in patients suffering from meningitis whether bacterial or viral. Nevertheless, advanced and more sophisticated laboratory tests should be carried out in complicated cases to make a correct and accurate diagnosis and to make a decision about the empirical drug therapy in these patients promptly

Key Words: meningitis, aseptic, CSF, pleocytosis

Citation of articles: 1. Muhammad Usman Anjum 2. Mohammad Mushtaq 3. Syed IrfanRaza Arif 4. ArshadWahab Shah. Role of Cerebrospinal Fluid Pleocytosis and its Biochemical Parameters in the Diagnosis of Aseptic Meningitis, Med Forum 2018;29(10):39-42.